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What do care home residents really want?

Thomas Hammer Jakobsen: finding ways to improve quality of life in care homes

In this era of growing numbers of old people and little money, care home providers will always be aiming to supply their services more efficiently and cheaply.

For the people on the receiving end, on the other hand, all that matters is quality of life. But in this relationship, they are definitely the vulnerable party – less organised, more diverse and facing far more difficulty in being heard.

I recently met Thomas Hammer Jakobsen of Copenhagen Living Lab, who is running a project in Denmark’s largest nursing home, Sølund, to identify how the experience of living in a care home could be improved. Copenhagen Living Lab’s ethnographic research, which involved joining residents for two months, uncovered a number of areas offering scope for change. Some of these were fundamental – residents wanted to be helped to hang on their ‘outside’ identity, for example, by strengthening their links to the past and being helped to conserve and celebrate their memories; they also wanted death treated as a normal part of life. And some wanted more specific things, such as an easy way for someone who is wheelchair-bound to close doors and windows.

Eight companies have now been brought in and are currently trying out solutions, some high-tech, some not (for example, counselling people before they come in to the home, to make the transition less abrupt and de-naturing). The first assessments of these will be made in a couple of months.

User-centred design based on ethnographic research has been highly fashionable among those trying to improve public services for some years now; but lately, some of the foremost thinkers in the field have warned against over-enthusiasm for all the collaborative innovation and co-creation (choose your buzzword). Simon Roberts, himself an anthropologist, points out in an excellent blog that user-centred design is not automatically a panacea. If you want a clever, nuanced explanation of the arguments you should read both his blog and another by Geoff Mulgan to which he links.

My rather slapdash journalistic sense of what they’re saying is that:

Designers can get too caught up in the research phase, so that identifying problems, rather than solving them, seems like the key task.

Doing the ethnography doesn’t guarantee that users will actually be involved in designing solutions.

‘Users’ are actually individuals. They’re not homogeneous and improving quality of life is complex and not always susceptible to systems, let alone a piece of technology.

Designers like to start from the premise that radical reorganisation is the only solution, but that may not necessarily be the case.

I’m looking forward to seeing what solutions emerge from Sølund. Thomas Hammer Jakobsen is persuasive and passionate, and he and his collaborators have introduced some quite simple things to do with keeping people warm, for example, as well as more ambitious ideas such as a way of giving dementia patients freedom to move around and explore their environment while ensuring they don’t wander off.

The arguments about user-centred design are likely to rumble on. It’s understandable that people are getting a bit weary of hearing about co-creation every time any change in services is mooted, but its central insights remain persuasive: of course users should be the starting point. And the best new products and services tend to arise out of and necessitate a new way of thinking about relationships.

What do care home residents really want? Can I hazard a guess and say…. what anybody living in their home wants! A comfortable easy safe place to live and be yourself and to be able to get support and help when you need it. To literally feel ‘at home.’

I’ve been doing some work with My Home Life recently and this initiative, based at City University, has some of the answers to what care home residents want. MHL is aimed at promoting quality of life for those living, dying, visiting and working in care homes. It concentrates on the positive work that is going on in care homes – there are plenty of shocking stories of the problems – and how these home personalise they care they give, help residents and their families to feel in control and involved and also to help managers of home to support their staff. People want to maintain their identity, be involved in decision-making and feel part of a community whether they live in a care home or any where.

There is lots of work going on to improve what care homes offer residents. I’m also involved in another piece of work to tackle the high level of medication that has been identified as causing ill health and disorientation in many care homes residents.
There’s also good information that’s useful for keeping care home staff up to date with latest thinking, for example on dementia. I was managing a website for SCIE called The Dementia Gateway http://www.scie.org.uk/dementia which offers free content by topic experts, good free films on dementia from Social Care TV and helpful links.

We need care homes to reach out and involve the local community. For example, some have open days or get local schools in to work with residents. There is so much more that needs to be done to make sure that people who live in care homes are not forgotten.